SUGAR TOLERANCE TESTS

j Cases is submitted, in each of which a glucose or Vl*lose tolerance test has been performed. The method used has been that practised by Hugh Maclean.1 ?All the patients on whom these tests have been Performed have been inor out-patients of the Bristol ?tteral Hospital. I am indebted to the physicians under 0se care they were for permission to publish these records, and to Professor Hadfield for advice and help. To obtain a graph for comparative purposes, a test a normal person (H. D. P.) was carried out. The reading of the percentage blood sugar represents a ?f a specimen of blood taken four hours and a half er breakfast. Fifty grams of glucose were then taken ^ ftiouth, and readings taken at half-hourly intervals rj^ririg the first two hours after taking the glucose. e specimens of blood were taken at times similar to ese in all the cases cited. The readings obtained were as follows: 0 093>


Maclean.1
?All the patients on whom these tests have been Performed have been inor out-patients of the Bristol ?tteral Hospital. I am indebted to the physicians under 0se care they were for permission to publish these records, and to Professor Hadfield for advice and help.
To obtain a graph for comparative purposes, a test a normal person (H. D. P.) was carried out. The reading of the percentage blood sugar represents a ?f a specimen of blood taken four hours and a half er breakfast. Fifty grams of glucose were then taken ^ ftiouth, and readings taken at half-hourly intervals rj^ririg the first two hours after taking the glucose. e specimens of blood were taken at times similar to ese in all the cases cited.
The readings obtained were as follows: 0 093> ^ 25, 0 -162, 0 112, 0 081. These readings may be Passed graphically. In  While she was in hospital sugar was found in her urine, fte blood sugar, estimated four hours after food, was 0-143. e Was discharged from hospital (urine sugar-free) on a labetic diet. She attended out-patients regularly, but the ^co.suria never reappeared on the diet (1,760 calories). specimen of urine taken before the test was sugar-free, another obtained an hour after taking the glucose contained 3 ? 3 per cent, sugar, while a third specimen obtained at the end of the test contained 1 ? 2 per cent, sugar.
The test, therefore, revealed a decreased sugar tolerance 011 the part of the patient. It was concluded that the glycosUrl|j was due to a lesion of the pituitary gland, and was connect?
with his other symptoms. The presence of a cranial tuni? was diagnosed. In August of the same year?one month after the the patient was readmitted into hospital with papilledema ^ other signs of increased intracranial pressure. Repeated lufl1^ punctures gave the patient marked relief, but he soon develop^.
Cheyne-Stokes breathing and died. At the autopsy a large of the cerebellum was found replacing the middle lobes obstructing the iter. A polycystic condition of the kidneys ^ also found with cyst-adenomatosis of the pancreas. Death ^ due to acute hydrocephalus.  June, 1927. nen he was admitted to hospital. The stools had been a little "? and putty-coloured, and he complained of lassitude, but herwise he felt quite well. On examination the spleen was u^d to be palpable and the liver enlarged and hard. No Cltes. Urine dark in colour. A Van den Bergh test done on ' Une 26th, 1927, showed a delayed and weakly positive direct a C 1011? and a strongly positive indirect reaction. In view of bio e diagnosis of acholuric jaundice, the fragility of the ^ cells was tested and found to be normal. V u^ose test for hepatic inefficiency (50 grams used) was 0-y positive.
The readings were as follows: 0 093, P 0-181, 0 075, 0 062. Poig S ^enz?l and allied substances are well known as hepatic ^??ns producing all grades of liver necrosis, the diagnosis was in^Ved at of subacute hepatic necrosis, due probably to the Nation of benzol fumes. The distinction between the last two cases cited (chronic hepatitis) and Case 5 (subacute hepatic necrosis) is well stressed by the results of the lsevulos? tests.
In the case of subacute hepatic necrosis the lesion is severe, very diffuse, and involves the parenchyma, as the toxic benzol compounds are probably conveyed by the blood stream. In the other two cases the lesion is less diffuse, and mainly affects the connective tissue. The parenchyma is thus left sufficiently healthy t? give a negative result with the hepatic inefficiency tests-Case 10.?The next case is not one in which a full sugaf tolerance test was done, as the diagnosis was unfortunately only too obvious. It illustrates, however, the type of case o severe diabetes which fails to respond to insulin treatment.
The patient was a married woman, aged 40. She ^va admitted into hospital on July 6th, 1927, in a comatose conditio1*-She had a history of two years' diabetes, but had never receive insulin treatment. The breath smelt sweet, she had air hunger> and the urine showed a heavy percentage of sugar and acidosis-Forty units of insulin were given, and at 5 p.m. on July 1927, the percentage of blood sugar proved to be 0 -4? ?
Repeated forty-unit doses of insulin were given, but the patie*1 showed no tendency to come out of her coma. i At 7 p.m. on July 6th, 1927, after 220 units of insulin b* been given, the blood sugar was still up to 0-443. Another units were given, and the blood sugar percentage fell to 0 4U only. The patient's condition, however, showed no improvemefl ' and after thirty-six hours in hospital she died, although ^ units of insulin had been given in that time, with very li^ fall in the percentage of sugar in the blood.

Summary.
A series of cases is described to exemplify ^6f diagnostic value of estimations of the body's tolerance 0 glucose and lsevulose, in differentiating the various of glycosuria and investigating the efficiency of the Hver' reference.